Kiwis need to swallow bitter pill about what health service can deliver

Demanding patients are getting priority over those who suffer in silence in our ‘unfair’ national health system, Gareth Morgan told an audience at the University of Otago, Christchurch, today.

Morgan was speaking at the first University of Otago, Christchurch, Mid-Winter Dialogue about his book on the state of the health system, Health Cheque.

Morgan said who gets treated in the health system was influenced by the media, politics and lobbying.

“The squeaky wheel gets the oil.’’

“That’s very wrong and should not be the case in a universal entitlement system,’’ Morgan told the audience.

He cited the example of breast cancer drug Herceptin. Lobbyists pressured the Government into subsidising the drug for a longer treatment course than Government drug-buying agency Pharmac originally decided.

Another example of the potential for ‘gaming’ in the health system was people bypassing their GP and going straight to emergency units to get higher levels of care.

Individual doctors were able to decide what level of care patients with the same condition received, leading to great disparity, Morgan said.

An impartial system was needed with a focus on investing public money to get the greatest health return, Morgan said.

He proposed the creation of an ‘apolitical’ body led by doctors to oversee health care funding.

This body would be allocated a certain amount of money by the Government and its members would decide what treatments should be available as a standard across the country, he said.

New Zealanders deserve to be told exactly what their health dollar can pay for rather than being given false expectations, Morgan said.

Morgan said in Health Cheque that a product of the health system established by Michael Joseph Savage was an expectation that every treatment for every patient would be fully funded.

The health system has struggled to meet these expectations, and in future the gap between expectations and delivery will grow increasingly wide, he said.

“Over the last decade, the average increase in total health expenditure has been 6% per annum, at a time when economic growth has barely managed half of that,’’ he said in Health Cheque.

The book is based on the economic analysis of Dr Morgan and his co-author former Treasury analyst Geoff Simmons. The authors also interviewed scores of health professionals.

They found New Zealand’s health system was in good shape given what we can afford to spend on it, largely thanks to the hard work of the people within the system.

However there are still enormous future challenges including rising expectations, the ageing population, new technology, poor productivity and the rise of chronic diseases.

“Something, somewhere has gone wrong with the logic of health spending and the pendulum may have swung too far towards investment in the elderly, while our low immunisation rates and high accident rates mean the state of young people’s health has begun ringing alarm bells in the OECD,’’ Morgan said.

Bureaucracy needed to be slashed (such as numbers of district health boards and primary care organisations) and financially unviable rural hospitals closed, he suggests in Health Cheque.

Smaller hospitals could be replaced with better air services for emergencies and more sophisticated primary care, Morgan said.